Experts evaluate role of genetic testing in oral medicine

October 03, 2014

Is there predictive, chairside value in genetic testing in oral medicine? Ask a number of experts and
you'll likely hear varied responsessome fairly simple, some rather complex.
Just such an opportunity is available Saturday, Oct. 11, from 8-9:30 a.m. when five notable experts
will address the topic with presentations followed by a Q&A session for the Introduce Scientific
Advances Into Your Clinical Practice forumwhich is also worth continuing education credits
for attendees.
"We're all different, from different trainings and different backgrounds," said panelist Dr. Jack
Gunsolley, "We're obviously talking about the same subject, but from very different viewpoints."
Dr. Gunsolley is director, Clinical Research Unit, Virginia Commonwealth University School of
Dentistry. In debating the merits of genetic testing in oral medicine, he will join these colleagues:Dr.
Scott Diehl, Ph.D., professor in oral biology and health informatics at Rutgers University.
Dr. Thomas Hart, Ph.D., director of Craniofacial Population Sciences Research and a professor at the
University of Illinois at Chicago in the Department of Periodontics. Dr. Hart is currently serving as
Vice Chair of the ADA Council on Scientific Affairs, and will serve as Chair in 2015.
Dr. Ken Kornman, Ph.D., founder of Interleukin Genetics Inc.
Dr. Peter Polverini, professor of oral and maxillofacial pathology in the Department
http://thedentaltrader.com/linkslist.htm of Periodontics and Oral Medicine, Division of Oral
Pathology/Medicine/Radiology at the University of Michigan School of Dentistry.
Dr. Michael Glick, editor of The Journal of the American Dental Association, and Dr. Daniel Meyer,
ADA senior vice president for Science and Professional Affairs, will host the forum. The pair seeks a
compelling and useful discourse on the topic in light of concerns in medicine and dentistry about the
role of genetic testing.
"The National Institutes of Health has put together cross-teams from all disciplines to look at genetic
testing and its relevance," Dr. Meyer said. "In the meantime, there have been some products that
have been introduced into dentistry that are intended to screen patients based on genetic testing."
Added Dr. Glick, "In medicine, they call it personalized medicine. Here, we call it personalized
dentistry or personalized dental care, meaning I can test you genetically and say, 'You need a
cleaning, not every six months but every 12 months or maybe every 24 months based on genetic
testing.' That's what's being done today, but we're not too sure the science justifies those types of
recommendations yet. That's what this panel is all about."
Though the assembled panelists are unlikely to see eye to eye on the topic, they will set out to
provide a frame of reference for dentists to judge for themselves the current science and clinical
applications for genetic testing in oral medicine.
Dr. Diehl suggested that the discussion is one
not to miss. "The panel includes leading
proponents of the alternative views of genetic
testing, so we are very likely to witness a very
stimulating and lively exchange," he said.
The point Dr. Diehl himself hopes to
make? "I believe there is great potential
for genetic testing to be of substantial value
for improving the diagnosis and treatment of
oral and dental diseases," he said. "However,
with the exception of rare syndromes, we do
not yet have sufficient data to support doing so
at the present time. Studies of thousands or
tens of thousands of patients assessed using
standardized clinical diagnoses, as has been
done for a number of major medical disorders
such as cancers, heart disease and diabetes, are likely to be needed in order to adequately
understand the complex and heterogeneous etiology of conditions such as dental caries and
periodontitis."
Dr. Diehl also said that the implications for how genetic testing in oral medicine affects insurance
will likely come up.
For his part, Dr. Polverini says that he is cautious about the use of these tests. He hopes the
discussion's value will be in "dispelling some myths about genetic testing and hopefully separate fact
from fiction."
"Given the participants, the discussion will be lively and informative," Dr. Polverini said. "My
personal view is there is a place for genetic testing, but one has to approach this new era of
'personalized oral health care' cautiously. There are clear examples where genetic testing has
proven invaluable, i.e., predicting the onset of certain cancers and guiding targeted cancer therapy.
However, with more complex diseases, including a number of common dental diseases, that involve
multiple genes and gene interactions, the value of genetic testing is less obvious.
"Nonetheless, it is an exciting area that over time will prove to be part of the dental practitioner
diagnostic and therapeutic tool box."
Dr. Gunsolley agrees that there may prove to be applications related to oral cancers, but he's not so
certain about therapeutic applications for other dental diseases. "I think that the main applications
are going to be in cancer-orientated areas," he said. "For more chronic diseases, like periodontal
disease and caries, I don't think there's utility down the road. That's my hypothesis."
Dr. Ken Kornman, whose company Interleukin has a genetic test for periodontal disease on the
market, says that the tests are indeed valuable to dentists. "Genetic information has several
clear places in oral medicine," he said. "It is still at an early phase of use, but it's pretty clear as to
where it's going.
"It's possible today with genetic information that's available to identify patients who are at increased
risk for severe periodontitis and use early preventive care to hopefully delay, slow down and ideally
prevent completely those patients from getting severe periodontitis," he said.
But Dr. Hart would like to see heartier science behind the use of genetic testing in oral medicine.
"While the FDA has begun to regulate some of these tests, the vast majority are not in fact regulated
for clinical validity or clinical utility," he said. "It is important for clinicians and patients to
understand the difference between different types of genetic tests so that they are aware of what
tests can and cannot do. This discussion is overdue, but is complicated because most dentists
receive relatively little formal education in human genetics in dental school and much of our
understanding of how genetics contribute to common complex diseases and the single nucleotide
polymorphisms tests behind these new tests has been developed in the last few years, after most of
the dentists now practicing graduated. So they have not been formally educated in this area of
genetics. This has created a lot of confusion.
"This discussion is a start in having a dialogue in the dental community regarding genetic testing,
particularly for common complex traits such as periodontitis, and realistically discussing the
potential and current limitations of such tests."
The free discussion (tickets required), CE course 7365, will take place in Room 214B in the Henry B.
Gonzalez Convention Center. The course is open to dentists, educators, researchers, industry
representatives, dental hygienists and dental assistants, who earn 1.5 hours of CE credits for
attending.
The open forum, Introduce Scientific Advances Into Your Clinical Practice, is sponsored by the ADA
Council on Scientific Affairs and The Journal of the American Dental Association with grant support
from The Task Force on Design and Analysis.